Provider Demographics
NPI:1750856753
Name:SIMPSON, ZACHARY TYSON
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:TYSON
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3114
Mailing Address - Country:US
Mailing Address - Phone:770-317-8849
Mailing Address - Fax:
Practice Address - Street 1:3697 HIGHWAY 5 STE 6
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6901
Practice Address - Country:US
Practice Address - Phone:678-501-5165
Practice Address - Fax:678-501-5170
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist